Provider Demographics
NPI:1992950216
Name:MALAMA NA MAKUA A KEIKI
Entity type:Organization
Organization Name:MALAMA NA MAKUA A KEIKI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUD
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-579-8414
Mailing Address - Street 1:PO BOX 790006
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-0006
Mailing Address - Country:US
Mailing Address - Phone:808-579-8414
Mailing Address - Fax:808-579-8426
Practice Address - Street 1:1931 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9718
Practice Address - Country:US
Practice Address - Phone:808-877-7117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health